HIV/AIDS Skepticism

Pointing to evidence that HIV is not the necessary and sufficient cause of AIDS

Circumcision pseudo-science

Posted by Henry Bauer on 2009/09/02

The possible benefits and drawbacks of male circumcision have been argued over for decades, centuries, probably millennia. The coincidence that a procedure originating as a religious ritual should turn out to have beneficial, health-protective side-effects is by no means impossible, though no one argues that case for the religious ritual of female circumcision. What’s clear is that medical opinion has been and continues to be divided [David L. Gollaher, “From ritual to science: the medical transformation of circumcision in America”, Journal of Social History, 28 #1 (1994) 5-36]:
“Ironically, but predictably in the context of the history of medical arguments for circumcision, some doctors have conjectured that removing the foreskin may protect men from the most dreaded epidemic of the post-modern world: the human immunodeficiency virus (HIV). Using retrospective data (the epidemiological equivalent of empiricism) from a venereal disease clinic in Kenya, for example, researchers observed that there were higher rates of HIV infection in the home communities of uncircumcised than circumcised men. Ignoring racial, ethnic, and sociocultural variables — the chief factors dictating whether or not an African boy is circumcised in the first place — they hypothesized that circumcision might serve to inhibit the transmission of the AIDS virus. One wonders whether this theory will endure. But within a medical community desperate to find some weapon against AIDS, its appeal is understandable. Even a physician who is a sober skeptic of the methodologies behind such studies allows that they ‘do suggest that HIV may be more infective during heterosexual intercourse if the male partner is uncircumcised and has a mucosal or cutaneous ulcer.’ [77] AIDS, the nemesis of modern science and medicine, remains a mystery. By some equally mysterious process, it is surmised, circumcision may help”.
[77: Simonsen et al., “Human Immunodeficiency Virus infection among men with Sexually Transmitted Diseases: Experience from a Center in Africa,” NEJM 319 (1988) 274-8; Cameron et al., “Female to male transmission of Human Immunodeficiency Virus Type I: Risk factors for seroconversion in men,” Lancet 2 (1989) 403-7; Marx, “Circumcision may protect against the AIDS virus,” Science, 245 (1989) 470-1; Poland, “The question of routine neonatal circumcision,” NEJM, 322 (1990) 1312-5”]

It is worth noting that circumcision as a way of avoiding becoming “HIV-positive” was mooted already in the late 1980s, and enthusiasts have continued to pursue definitive evidence for that for some two decades, despite contraindications no less probative than the pro-indications: a number of studies have found circumcision to be NOT associated with a lower rate of “HIV-positive”; see, for example, those cited in “Rwanda: Circumcise all men — even if it means more ‘HIV’ ‘infection’” [3 February 2008].

I’ve commented before on the remarkable similarities between HIV/AIDS and topics often labeled pseudo-science [“Science Studies 102: Burden of proof, HIV/AIDS ‘science’, pseudo-science”, 22 July 2008;  “HIV/AIDS and parapsychology: science or pseudo-science?”, 30 December 2008;  “Mainstream pseudo-science good, alternative pseudo-science bad”, 25 February 2009]. The failure after two decades of effort to find conclusive proof that circumcision prevents “HIV-positive” is somewhat reminiscent of decades of enthusiastic seeking of evidence for the reality of UFOs or the existence of Nessies; though one might have imagined, perhaps naïvely, that it might be easier to observe circumcision and frequency of “HIV-positive” than to investigate objects like UFOs or Nessies that cannot be brought under observation on command. Still, as Scientific Explorers like to say, “absence of evidence is not evidence of absence”.

At any rate, two decades of observational studies have been inconclusive as to whether there is an association between circumcision and “HIV-positive” status. A recognized problem is the number of potentially confounding factors in these observational studies, primarily cultural and religious characteristics that are often correlated with genetic characteristics.

A powerful argument that CIRCUMCISION DOES NOT PROTECT against “HIV-positive” status comes from solid and consistent observational data on cohorts of gay men. Universally, the groups most frequently testing “HIV-positive” are drug abusers and gay men; in the official jargon, injecting drug users (IDU) and men who have sex with men (MSM). Since IDU are supposedly infected via needles that do not normally make contact with the foreskin, MSM are the group most at risk for acquiring “HIV-positive” status via the foreskin; therefore this would be the ideal group for detecting any preventive effect of circumcision. But a review of 18 such studies found no preventive effect of circumcision against “HIV-positive” among MSM: Millett et al., “Circumcision status and risk of HIV and sexually transmitted infections among men who have sex with men”, JAMA, 300 [2008] 1674-84.

How then does it come about that the HIV/AIDS Establishment has accepted as an article of faith that circumcision reduces by half the risk of becoming “HIV-positive”? For example,

“CDC mulls routine circumcision of infants to reduce spread of HIV” (Tracy Miller, 25 August 2009)
“In an effort to reduce the spread of the AIDS-causing HIV virus, the Centers for Disease Control are currently mulling routine circumcision for all baby boys born in the United States . . . . The controversial recommendations, scheduled for a formal release by the end of the year, come on the heels of research that shows circumcised men in African countries hit hard by AIDS had half the risk of getting infected as those who were uncircumcised.
Critics say that focusing on newborns in the United States would only have an effect years down the road, and that circumcising infants subjects them to medically unnecessary surgery without their consent.
But CDC experts maintain that any step to reduce the spread of HIV is worthy of serious consideration.
‘We have a significant H.I.V. epidemic in this country, and we really need to look carefully at any potential intervention that could be another tool in the toolbox we use to address the epidemic,’ Dr. Peter Kilmarx, chief of epidemiology for the CDC’s division of HIV/AIDS prevention, told the Times. ‘What we’ve heard from our consultants is that there would be a benefit for infants from infant circumcision, and that the benefits outweigh the risks.’
Experts acknowledge that a new circumcision policy is unlikely to have a dramatic effect in HIV infection rates, as most adult men are already circumcised. Additionally, scant evidence exists to prove circumcision protects homosexual men from getting HIV.
79 percent of adult American men are already circumcised, according to public health statistics, though circumcision of newborns has dropped to about 65 percent in recent decades” [emphases added].

Note the usual bureaucratic prevarications:
— Unnamed “experts” and “consultants” are cited in the attempt to outweigh the actual scientific evidence;
— “a significant H.I.V. epidemic” is asserted to exist in the USA, contrary to fact;
— however, insofar as there may be an appreciable frequency of  “HIV-positive” instances in the USA, a large proportion is among MSM, who have been found NOT to benefit in this respect from circumcision;
— and that fact is euphemized or obfuscated by saying “scant evidence exists” instead of that the evidence speaks clearly against any benefit from circumcision.

Note too, “on the heels of research”: It is elementary that new research is not to be relied on until it has been confirmed over time by independent investigators and in a variety of circumstances. This rush to judgment is junk science. REAL SCIENCE ISN’T NEWS [Scientific illiteracy, the media, science pundits, governments, and HIV/AIDS, 15 January 2009].

Since HIV/AIDS theorists do not hesitate to swallow absurdities wholesale, they do not blink at the suggestion that “While circumcision may help protect heterosexual men in Africa from contracting HIV, . . .  it does not appear effective in doing so for American gay men, according to the largest study yet on the issue. . . . Circumcision ‘is not considered beneficial’ for gay men concerned about lowering their risk of becoming infected with HIV, Dr. Peter Kilmarx of the CDC told the Associated Press. He released the study findings at a conference on Tuesday. . . . But circumcision may not offer the same protection when it comes to anal sex, Kilmarx said.” [“Circumcision won’t shield gay men from HIV: Study” ].
Here once more the HIV/AIDS gurus would like to swing both ways, or perhaps every way. On the one hand, it is an hoary shibboleth that gay men are particularly at risk because anal sex is more conducive to “HIV transmission” than is vaginal sex, because of a greater likelihood of skin breakage and blood contact. But in order to justify a program of universal circumcision, it becomes expedient to take somehow the opposite view.

Why would circumcision be preventive?
“Scientists think circumcision can protect against HIV because the tissue of the foreskin has a high number of target cells for HIV infection and is susceptible to tearing during intercourse, providing an entry point for the virus” [“Circumcision: Change in medical opinion possible”].
But, again, anal sex is supposed to pose a greater risk for tearing skin than does vaginal sex. “I also find it fascinating that the male prepuce has gone straight from being an inconsequential ‘flap of skin’ to being a complex immunological organ, just in time to be infected by a virus that targets immune cells” [Winkel, “Rush to judgment”, PLoS Medicine 3(1) (2006) e71].

So the official conclusion is not only highly implausible, it is contrary to the facts accumulated over some twenty years or so. Yet all that is jettisoned by reliance on 3 brand-new clinical trials in Africa, all of them stopped prematurely after a year, that have supposedly shown definitively that circumcision reduces by about 50% the risk of becoming “HIV-positive” — among African heterosexual men, that is, though not among American gay men [Gray et al., “Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial”, Lancet, 369 (2007) 657-66; Bailey et al., “Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial”, ibid., 643-56; Auvert et al., “Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: The ANRS 1265 trial”, PLoS Medicine 2(11) (2005) e298].
A detailed deconstruction of these reports has to be deferred to a later post, this one is already longer than I prefer, but at least one feature of them is readily cited and adds greatly to the implausibility of the conclusion drawn:
In all three trials — in South Africa, Uganda, and Kenya —, the purported effect of circumcision was essentially the same at 50-60%, and it was independent of all other observed variables, among them number of sexual partners, non-marital relationships, condom use, paying for sex, drinking alcohol before sex, age, marital status, education (so stated specifically in Gray et al.).
Think about that. The probability of acquiring any sexually transmitted infection must depend on the probability of intercourse with an already infected person, which itself depends on the prevalence of the infection in the population; also influential will be the number of acts of intercourse and the number of partners, and whether sex is “social” or paid for, because prostitutes are by shibboleth supposed to be a reservoir of HIV and STDs; important too must be the care taken to protect via condoms, which is supposedly influenced by the state of sobriety or lack of it. Yet in 3 different cultures, in 3 widely separated regions of Africa, with groups of different age ranges, and where the incidence of “HIV-positive” in the control groups differed  significantly, somehow all those variables turn out to balance one other so precisely that the overall effect of the studied treatment is almost exactly the same. This strikes me as about as likely as 2 blue moons in the same year, or as Nessie surfacing just as I’m greeted by an alien emerging from a landed UFO.

There is quite a good reason, actually, why all 3 studies should have delivered the same apparent effect of circumcision, but it has nothing to do with “HIV” or sexual transmission: Surgery is well known to suppress immune function. Now the standard test for “HIV” is actually a test for antibodies, and the evidence is ample that “HIV” tests are highly non-specific, reacting “positive” when large numbers of a variety of antibodies are present. Since post-operative antibody production is lower as a consequence of surgery, post-operative apparent “HIV” incidence will be lower.

These clinical trials have demonstrated only that surgery cuts by about half (50-60%) the production of non-specific antibodies.

25 Responses to “Circumcision pseudo-science”

  1. Mark Lyndon said

    In Europe, almost no-one circumcises unless they’re Muslim or Jewish, and they have significantly lower rates of almost all STI’s including HIV.

    Even in Africa, there are six countries where men are more likely to be HIV+ if they’ve been circumcised: Rwanda, Cameroon, Ghana, Lesotho, Malawi, and Swaziland. Eg in Malawi, the HIV rate is 13.2% among circumcised men, but only 9.5% among intact men. In Cameroon, the HIV rate is 4.1% among circumcised men, but only 1.1% among intact men. If circumcision really worked against AIDS, this just wouldn’t happen. We now have people calling circumcision a “vaccine” or “invisible condom”, and viewing circumcision as an alternative to condoms.

    ABC (Abstinence, Being faithful, Condoms) is the way forward. Promoting genital surgery will cost lives, not save them.

  2. Philip said

    in my native Philippines, the relatively slow spread of “HIV” is sometimes attributed to the high circumcision rate. I have yet to see numbers, though.

    • Mark Lyndon said

      The Philippines does have a low rate of HIV, but no lower than Poland for example, where almost everyone is Catholic and not circumcised. Interesting the traditional form of circumcision in the Philippines is a dorsal slit, which doesn’t actually remove any of the foreskin, and so should have no effect on HIV transmission anyway (according to the usual proposed explanation of why male circumcision might have an effect).

    • In the Philippines, the majority of the male population is circumcised, as it is seen as an important rite of passage. In the 2010 Global AIDS report released by UNAIDS in late November, the Philippines was one of seven nations in the world which reported over 25 percent in new HIV infections between 2001 and 2009, whereas other countries have either stabilized or shown significant declines in the rate of new infections. Among all countries in Asia, only the Philippines and Bangladesh (another country where circumcision is prevalent due to Islam) are reporting increases in HIV cases, with others either stable or decreasing.

  3. Sabine Kalitzkus said


    You made many words to distract your readers from the only one sentence in your post that is really worth mentioning. It hides somewhere in the middle of this long post and lacks any kind of typographical emphases. Here it is:

    “… and that circumcising infants subjects them to medically unnecessary surgery without their consent.” (Emphases mine.)

    No sane and unbrainwashed boy or girl would ever give their consent to being mutilated.

    For three or four millennia adults have come up with an impressing variety of “logical” explanations and justifications for their crime of terrorizing and mutilating innocent infants and children who are too young to defend themselves. This “HIV”-b***s*** is just another “modern” variation of their justifications.

    When an adult man decides himself to agree with becoming mutilated, he does so out of his own free will. It is his body, he has the right to decide what to do with it or what to allow others to do with it. He even has the right to accept the most ridiculous reasoning for the mutilation of his body.

    Infants and children have no rights whatsoever. We freed them from all of their innate and natural rights some thousands of years ago. They are left with only two things: the right to endure the pains and the obligation to love the adults who are causing the pains.

    The mutilation of infants and children is a crime and there is no excuse for it.

  4. Mark Lyndon said

    Mark Lyndon: Please share the sources for the rates in those countries.

    Cameroon: table 16.9, p17 (4.1% v 1.1%)
    Ghana: table 13.9 (1.6% v 1.4%)
    Lesotho: table 12.9 (22.8% v 15.2%)
    Malawi: table 12.6, p257 (13.2% v 9.5%)
    Rwanda: , table 15.11 (3.5% v 2.1%)
    Swaziland table 14.10 (21.8% v 19.5%)

    See also

    Conclusions: We find a protective effect of circumcision in only one of the eight countries for which there are nationally-representative HIV seroprevalence data. The results are important in considering the development of circumcision-focused interventions within AIDS prevention programs.

    Results: … No consistent relationship between male circumcision and HIV risk was observed in most countries.

    Something is very wrong here. These people aren’t interested in fighting HIV, but in promoting circumcision (or sometimes anything-but-condoms), and their actions will cost lives not save them.

    If you read those reports btw, the level of knowledge about HIV is quite frightening. In Malawi for instance, only 57% of women know that condoms protect against HIV/AIDS, and only 68% of women know that limiting sexual partners protects against HIV/AIDS. There are people who haven’t even heard of condoms. It just seems really misguided to be hailing male circumcision as the way forward. It would help if some of the aid donors didn’t refuse to fund condom education, or work that involves talking to prostitutes. There are African prostitutes that sleep with 20-50 men a day, and some of them say that hardly any of the men use a condom. If anyone really cares about men, women, and children dying in Africa, surely they’d be focussing on education about safe sex rather than surgery that offers limited protection at best, and runs a high risk of risk compensatory behaviour.

    • Henry Bauer said

      Mark Lyndon: Though I’m sure “HIV” isn’t sexually transmitted and has no causative association with “AIDS”, I can fully support supplying condoms to prostitutes to help guard against actual STDs and advice that more partners means a higher risk of STDs.
      I’m an enthusiastic supporter of President Obama because of such attitudes as that one need not agree on everything to be able to agree productively on some things — in this case, that circumcision in the attempt to prevent spread of “HIV” is quite unwarranted. I also agree that the drive for circumcision reflects a desperation that all other approaches have failed — microbicides and vaccines in particular. You may also be right, that the anti-condom pressures in the United States may exacerbate that frustrated desperation.

    • According to USAID, “there appears no clear pattern of association between male circumcision and HIV prevalence—in 8 of 18 countries with data, HIV prevalence is lower among circumcised men, while in the remaining 10 countries it is higher.”

      Click to access CR22.pdf

      The latest study in Kenya finds no association between male circumcision and lowered HIV rates:
      ‘Using a population-based survey we examined the behaviors, beliefs, and HIV/HSV-2 serostatus of men and women in the traditionally non-circumcising community of Kisumu, Kenya prior to establishment of voluntary medical male circumcision services. A total of 749 men and 906 women participated. Circumcision status was not associated with HIV/HSV-2 infection nor increased high risk sexual behaviors. In males, preference for being or becoming circumcised was associated with inconsistent condom use and increased lifetime number of sexual partners. Preference for circumcision was increased with understanding that circumcised men are less likely to become infected with HIV.’

  5. Sabine Kalitzkus said


    “Something is very wrong here.”

    I agree with you fully.

    “In Malawi for instance, only 57% of women know that condoms protect against HIV/AIDS, and only 68% of women know that limiting sexual partners protects against HIV/AIDS.”

    Considering the fact, that neither condoms nor limiting sexual partners protect against “HIV/AIDS”, we should be happy that it is only 57% and 68%, respectively, who have swallowed this lie. Otherwise even more Africans would have to suffer like Onnie.

    Your link to the International AIDS Society by the way went into the void. But curious as I am, I became interested in their partners. One of them is an organization called “NAM”, which exists “to support the fight against AIDS with independent, accurate, accessible and comprehensive information.” (Emphasis mine.)

    Independent, accurate etc. information. Let’s check it. NAM is the publisher of “”, which receives funding from “a wide range of sources”, like for example:

    Abbott Laboratories; Abbott Fund; Boehringer Ingelheim; Bristol-Myers Squibb; Delphic Diagnostics; Diana, Princess of Wales Memorial Fund; Elton John AIDS Foundation; F. Hoffmann-La Roche; Gilead Sciences; GlaxoSmithKline; Merck & Co.; Merck Sharp & Dohme; Pfizer; Roche; Sanofi Pasteur MSD; Schering-Plough; Tibotec; UNAIDS; WHO; and many others.

    Mark, would you kindly share your sources for your unbelievable claim that African prostitutes serve up to FIFTY clients a day?

    In the meantime I’m trying to figure out how these amazing African Superwomen might handle their jobs practically.

    Presuming African prostitutes are human beings, I expect them to eat three times a day and to sleep about seven hours a night. Presuming typical African conditions, preparing these meals takes several hours a day. Obviously African Super-Prostitutes must have somebody right next door who prepares their meals for them. And there must be other helpful people to take care of the prostitutes’ kids, because — as Onnie explained in one of her comments — hungry kids and irresponsible men are the main reasons why some African women have to work as prostitutes.

    Assuming all of these problems are solved, an African Super-Prostitute might be able to work ten hours a day, i.e. serving five clients an hour.

    Five clients per hour means twelve minutes of service-time per client — theoretically. Practically things are a bit more complicated.

    Here we are talking about “HIV-transmission” that is claimed to be caused by condom-free sex. As even the orthodoxy confesses, “HIV” cannot be “transmitted” via oral sex. That means we are talking about genuine penetration — a condom-free one. Thus we are talking about five genuine condom-free penetrations performed by five different clients every hour, ten hours a day.

    As this African Super-Prostitute has to clean herself after every client (or would you like to …?), there are only seven minutes of service-time left per client. Men are quick sometimes, some of them are even quicker than others, so this seven-minute-quickie could even be realistic somehow.

    However, it would only be realistic if the next client would already be present to take over as soon as his predecessor has finished. Given the realities of the African infrastructure and public transport systems (that means walking long distances), there must be a queue of four or five men waiting in front of the African Super-Prostitute’s house throughout the day to enable her to endure FIFTY seven-minute-quickies each and every day.

    “… and some of them say that hardly any of the men use a condom.”

    This is the reality for almost every woman on this planet. Men simply don’t like condoms. You have to convince them … and only sometimes, when they are in a good mood … they might even agree.

    And now, Mark, please go next door and ask your neighbor (this nice one in her early thirties), what her body would feel like after FIFTY condom-free penetrations within one single day. And don’t forget to share her reaction to your question in your next comment.

  6. Mark Lyndon said

    The link appears correctly, but when you click on it, it takes you to an address with an extra digit attached. If you take off the last digit, the link works, or just click here:

    I do believe that condoms and limiting sexual partners protect against HIV/AIDS btw. I just think that promoting male circumcision will make things worse, not better.

    I don’t think 50 clients a day is unrealistic at all, and the “service time” for women having sex that often is a lot shorter than 12 minutes. I can’t find the article I was looking for, which was talking about conditions at a particularly busy truck-stop, but here are some other links talking about what’s possible:
    (article about a woman in Nairobi who appears to be immune)
    “On an average day, she might entertain five or six clients. On a good day, 10. In the course of her career, she has probably had sex more than 50,000 times. The encounters are basic – lasting around two minutes each…”

    This link talks about up to 30 clients a day in India:

    This study was in Kenya:
    “some of the sex workers have up to 30 clients per day”
    “20 to 30 clients per day” (India)
    The establishment has six in-house sex workers, who see an average of 30 clients a day (Mozambique)
    “Each woman serviced from 15 to 60 clients a day.” (Japan’s “comfort women” and GI’s)
    “Some had been forced to “service” up to 60 clients a day.” (trafficked women in the UK)

  7. Sabine Kalitzkus said


    Thank you for all these links. I’ve just begun to read the stories, but already stumbled upon suspicious wording in the very first one.

    The Telegraph-story for example says:

    “The word [Majengo] means “slum” in Swahili, and never was anywhere more appropriately named; the unmade streets are narrow and treacherous, the tiny houses dilapidated, the air malodorous, the atmosphere — at least for outsiders — menacing.”

    I’ve been in Nairobi in the eighties and I can assure you, the reality is a lot more ugly than the story suggests. The majority of the Majengo-people don’t live in houses or huts and they don’t have toilets. If you would have to live under such conditions and you would become sick, would you really be in need of virus to explain your sickness?

    And then the story continues:

    “… a small number of local prostitutes — while susceptible to other venereal diseases, such as syphilis and gonorrhoea — were not contracting Human Immuno-deficiency Virus.” (Emphasis mine.)

    Funny, isn’t it?

    “Kenyan men like their sex nyama kwa nyama — flesh to flesh…”

    All men like that — and all women.

    Another quote:

    “It also seems, bizarrely, that the immunity fades if sexual activity ceases.”

    For people who don’t believe in “HIV”, there’s nothing bizarre with this phenomenon.

    “Gloomy and humid, the one-room shack is 8ft-square, with no electricity, running water or furniture apart from the two beds.”

    No clean water, no electricity, a menacing and malodorous environment, but people still need a phantom-virus…

  8. Circumcission is the in thing today in our Country. Funding is all for it, due to the fact that is I said ” to reduce TRANSMISSION RISK of HIV from female to male.”

    I thought that too, but now I am dead wrong even if this site can be wrong circumcission is useless in HIV Transmission because HIV as an entity is not transmissable, because it an’t there.

    If I wanted the funding that very one is getting from HHIV and AIDS Dogma, easy I would get that, but i will never sacrifice human life for money, never, starving or not!

    there is too much regulations for sex that I wonder if the followers of the regulations ever get an orgasm, its also part of healthy living and healthy relationships.( EXCUSE ME I AM BEING RUDE HERE, BUT ITS A FACT)

  9. Edward said

    There may also be a correlation between circumcision and economic status. Nyanza province in Kenya where the Kisumu study was done, and people do not circumscise, is generally less well off than central province where people largely circumcise.

    It would be interesting to see whether such a relationship holds for Rakai, Uganda and the SA location.

    Being Kenyan and growing up in the 80’s and early nineties there, I remember the advent of the HIV/AIDS scare from about 1986 through the early 1990s. At the time we were told that the infection rates were highest at the coast around the port city of Mombasa. There the population is Muslim and circumcises.


  10. Philip said

    “There is quite a good reason, actually, why all 3 studies should have delivered the same apparent effect of circumcision, but it has nothing to do with “HIV” or sexual transmission: Surgery is well known to suppress immune function. Now the standard test for “HIV” is actually a test for antibodies, and the evidence is ample that “HIV” tests are highly non-specific, reacting “positive” when large numbers of a variety of antibodies are present. Since post-operative antibody production is lower as a consequence of surgery, post-operative apparent “HIV” incidence will be lower.”

    I missed this before, but I must comment on it now. I would like some clarification on the statement “surgery is well known to suppress immune function.” I am a medical doctor but not a surgeon, so my surgical knowledge is limited to basic surgery classes and hospital clerkships and internships. From what I know though,surgery involves a lot of trauma, which in turn leads to increased wound healing processes. The granulation tissue formed and subsequent scarring is a result of increased immune function, not a decrease. Rather, the immune suppression associated with transplant surgery is not from the surgery itself, but due to immunosuppressive drugs given to combat transplant rejection. Organ rejection is in turn a result of increased, not decreased immune function. At least, that is my understanding.

    Of course, that is only my basic understanding. We all know that the immune system is much more complex than we can imagine. I would appreciate some clarification on this.

    Besides, if HIV is not sexually transmitted, it doesn’t really matter if one is circumcised or not. Rather, I agree that one should look at the socioecomonic status of patients and how this relates to circumcision.

    • Henry Bauer said

      Philip: By Googling “Surgery ‘immunosuppression'”, I quickly found several articles about surgery itself suppressing immune function, for example

      1: AACN Clin Issues. 2005 Jul-Sep;16(3):302-9; Surgery-induced immunosuppression and postoperative pain management.
      Page GG.
      Surgery is well-known to result in the suppression of some immune functions; however, the role of perioperative pain has only recently been studied. Pain-relieving anesthesia techniques and perioperative analgesia provide some protection against surgery-induced immune suppression and infectious surgical sequelae, although few studies also assess postoperative pain. Attributing a biological consequence to the observed immune alterations remains an issue in human studies, and the use of immune sensitive tumor models in animals enables the linking of immune changes with disease and a means by which to explore causal relationships among surgery-related pain, immune function, and metastatic development. There is strong evidence in animals that pain-relieving interventions significantly reduce the tumor-enhancing effects of undergoing and recovering from surgery. It cannot be assumed that animal findings are directly applicable to the human condition; however, if such relationships hold in humans, perioperative pain management becomes an important strategy for reducing postoperative sequelae.
      PMID: 16082233 [PubMed – indexed for MEDLINE

      2. Infect. Immun., Jun 1997, 2283-2291, Vol 65, No. 6; Distinct mechanisms of immunosuppression as a consequence of major surgery.
      T Hensler, H Hecker, K Heeg, CD Heidecke, H Bartels, W Barthlen, H Wagner, JR Siewert and B Holzmann.
      Altered host defense mechanisms after major surgery or trauma are considered important for the development of infectious complications and sepsis.

      • Philip said

        Thanks for the references, sir. Again we are taught that the more we know, the more we realize how much we don’t know.

        What also comes to mind is the idea that perhaps this is a self defense mechanism of the body to prevent the precise over-inflammation I was talking about relating to wound healing.

        Scenario one: cut em up, nice wound healing.

        Scenario two: cut em up, too much inflammation, body tries to compensate by immune modulation, decreased overall immune response after initial spike.

        Scenario three: cut em up, too much inflammation, too much immune reaction – positive HIV test? that’s food for thought…

  11. MacDonald said

    Circumcision is not a major intervention, careful now. Not too many Google results on circumcision-immune deficiency

    • Henry Bauer said

      MacDonald: I cited just two, and the first one doesn’t say “major”. Several of my doctors, including surgeons, are very chary of ANY so-called “invasive procedure”. Even inflammation sends signals to the immune system.
      But I’d welcome some other suggestions as to why 3 trials with very different populations should magically give the same apparent effect, when observational trials and surveys find no effect, particularly in the best controlled studies, namely, in the United States. Note too the flaws in those trials that I’ve pointed to in some detail.

  12. MacDonald said

    What I meant is, it is relatively uncontroversial to assume that circumcision has some effect on body chemistry. But to claim this effect is so intense and long-lasting that it would influence an HIV test several months or years later is a bit of a leap.

    Also, since this hypothesis does not explain the many cases where no difference is observed, I believe one should be careful.

    It is a brillant observation that 3 different studies in 3 different locations having identical outcomes ought to have raised some eyebrows.

    But it would be equally eyebrow-raising if the antibody-suppressing effects of the surgical intervention would show such uniform results in 3 different settings.

    • Henry Bauer said

      MacDonald: I don’t disagree, it’s just that I have not been able to find any other explanation. It seems also that the intervention group was less exposed to contagious agents for as long as a couple of years after the surgery, but why would that have averaged out so quantitatively the same?
      I’m more sure that circumcision was NOT the cause for less “HIV+”, than I am of what the actual cause may have been. Surgery itself seems to be the only known common factor.

  13. MacDonald said

    it’s just that I have not been able to find any other explanation

    Me neither. I am a conspiracy theorist on this one. I believe at a minimum that expectations, bias and pressure to deliver plays a large role in these studies.

  14. One of the biggest flaws in all three “trials” is the lack of a causal link between the presence of a foreskin and an increased transmission of HIV.

    Read the fine print; in is assumed a priori that circumcision has a “protective effect” that can be measured.

    Measuring a “protective effect” that has yet to be scientifically observed is like measuring the amount of damage the chupacabras causes to the dairy industry.

    Various hypotheses have been suggested in regards to the mechanism whereby circumcision prevents the transmission of HIV. They have all been disproven, however, and all of the “studies” attempting to establish a causal link between circumcion and HIV transmission remain unsubstantiated by a working hypothesis.

    Perhaps the oldest hypothesis on the mechanism whereby circumcision prevents the transmission of HIV is the theory that suggests that the keratinized surface of the penis in circumcised male resists infection, while the mucosa of the glans and inner of the intact male are ports of entry, which was purported by Aaron J. Fink.

    Recent studies, however, disprove this hypothesis. One study found that there is “no difference between the keratinization of the inner and outer aspects of the adult male foreskin,” and that “keratin layers alone were unlikely to explain why uncircumcised men are at higher risk for HIV infection.”[1] Another study found that “no difference can be clearly visualized between the inner and outer foreskin.”[2]

    The Langerhans cells have been suggested as the prime port of entry for the HIV virus. According to the hypothesis, circumcision was supposed to prevent HIV transmission by removing the Langerhans cells found in the inner mucosal lining of the foreskin.

    deWitte found that not only are Langerhans cells found all over the body and that their complete removal is virtually impossible. Furthermore, deWitte found that Langerhans cells that are present in the foreskin produce Langerin, a substance that has been proven to kill the HIV virus on contact, acting as a natural barrier to HIV-1 transmission by Langerhans cells.[3]

    The penile microbiome hypothesis attempts to identify the change in bacterial environment that results in the penis as a result of circumcision, as the mechanism whereby circumcision reduces the spread of HIV transmission. A desparate ad-hoc hypothesis, the explanation is rather farfetched. The argument is that the change in bacterial environment after circumcision makes it difficult for bacteria that cause diseases to live; there are less chances for penile inflamation, a condition that facilitates the transmission of viruses. The chances for penile inflamation are reduced, thereby reducing the chances of sexually transmitted viruses, such as HIV.[4]

    Presenting this hypothesis presents a two-fold problem. First, it presents an irrelevant conclusion; the randomized control trials were measuring frequency in HIV transmission, not for frequency in penile bacterial inflamation, and whether said inflamation facilitated sexually transmitted HIV. And secondly, circumcision advocates give themselves the new burden of proving the newly introduced hypothesis, that change in bacterial infection does indeed result in a significant reduction of HIV transmission. A new study is needed to measure HIV transmission in men who have been circumcised, uncircumcised men with constant penile inflamations, and uncircumcised men who don’t suffer constant penile inflammation. Unless the randomized controlled studies were limited to only uncircumcised men who suffered constant penile inflammation.

    The so-called “trials” provide interesting statistics (an exaggerated relative number), but without a causal link, I’m afraid the numbers we see are nothing but anecdotal evidence.

    1. Dinh, MH; McRaven MD, Kelley Z, Penugonda S, Hope TJ (2010-03-27). “Keratinization of the adult male foreskin and implications for male circumcision.”. AIDS 24 (6): 899-906. PMID 20098294. Retrieved 2011-06-28. “We found no difference between the keratinization of the inner and outer aspects of the adult male foreskin. Keratin layers alone are unlikely to explain why uncircumcised men are at higher risk for HIV infection.”.
    2. Dinh, Minh H; Sheila M Barry, Meegan R Anderson, Scott G McCoombe, Shetha A Shukair, Michael D McRaven, Thomas J Hope (2009-12-06), “HIV-1 Interactions and Infection in Adult Male Foreskin Explant Cultures” (PDF), 16th Conference on Retroviruses and Opportunistic Infections, Montreal, Canada,, retrieved 2011-06-28, “No difference can be clearly visualized between the inner and outer foreskin.”
    3. de Witte, Lot; Alexey Nabatov, Marjorie Pion, Donna Fluitsma, Marein AW P de Jong, Tanja de Gruijl, Vincent Piguet, Yvette van Kooyk, Teunis B H Geijtenbeek (2007-03-04). “Langerin is a natural barrier to HIV-1 transmission by Langerhans cells” (PDF). Nature Medicine. doi: 10.1038/nm1541. Retrieved 2011-06-28.
    4. Price, Lance B.; Cindy M. Liu, Kristine E. Johnson, Maliha Aziz, Matthew K. Lau, Jolene Bowers, Jacques Ravel, Paul S. Keim, David Serwadda, Maria J. Wawer, Ronald H. Gray (2010). “The Effects of Circumcision on the Penis Microbiome”. PLoS ONE 5 (1). doi: 10.1371/journal.pone.0008422. Retrieved 2011-06-29. “The anoxic microenvironment of the subpreputial space may support pro-inflammatory anaerobes that can activate Langerhans cells to present HIV to CD4 cells in draining lymph nodes. Thus, the reduction in putative anaerobic bacteria after circumcision may play a role in protection from HIV and other sexually transmitted diseases.”.

    • Henry Bauer said

      Joseph Lewis:
      Since the earlier comments presented data clearly falsifying the circumcision-protection hypothesis, yes, those clinical trials mean nothing (except that an unsound theory makes room for endless “research”).

  15. Bragalou said

    Neurologically, the most specialized pressure-sensitive cells in the human body are Meissner’s corpuscles for localized light touch and fast touch, Merkel’s disc cells for light pressure and tactile form and texture, Ruffini’s corpuscles for slow sustained pressure, deep skin tension, stretch, flutter and slip, and Pacinian corpuscles for deep touch and detection of rapid external vibrations. They are found only in the tongue, lips, palms, fingertips, nipples, and the clitoris and the crests of the ridged band at the tip of the male foreskin. These remarkable cells process tens of thousands of information impulses per second and can sense texture, stretch, and vibration/movement at the micrometre level. These are the cells that allow blind people to “see” Braille with their fingertips. Cut them off and, male or female, it’s like trying to read Braille with your elbow. Gary Harryman

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